Key result
CTA improves diagnostic accuracy for ACS over hsTn in emergency department patients with AUC 0.96.
Why the study?
Rapid and accurate identification of patients with ACS in the ED presenting with acute chest pain is challenging, and the diagnostic utility of CTA versus hsTn needed assessment and comparison.
Does computed tomography angiography improve the diagnostic accuracy for acute coronary syndrome compared to high-sensitivity troponin in emergency department patients presenting with acute chest pain?
Meta-Analysis (n=4,239)
Yes
Does computed tomography angiography improve the diagnostic accuracy for acute coronary syndrome compared to high-sensitivity troponin in emergency department patients presenting with acute chest pain?
Absolute Event Rate: 0.96% vs 0.86%
p-value: p=<0.05
Computed tomography angiography exhibits superior diagnostic accuracy compared to high-sensitivity troponin for ruling out acute coronary syndrome in ED patients with low-to-intermediate risk chest pain.
Supports CTA prioritization over hsTn for ACS diagnosis in ED chest pain; confirms superior accuracy in updated meta-analysis.
Background: Rapid and accurate identification of patients with acute coronary syndrome (ACS) in the emergency department (ED) is no easy task. This study aimed to assess and compare the diagnostic utility of computed tomography angiography (CTA) and high-sensitivity troponin (hsTn) for patients with ACS in the ED. This meta-analysis focuses on patients presenting with acute chest pain. Methods: All relevant articles were retrieved from PubMed, Embase, and the Cochrane Library up to October 2025. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Pooled results were presented with 95% confidence intervals (CIs), and appropriate models were selected based on study heterogeneity. Diagnostic performance was expressed as the area under the curve (AUC). Heterogeneity of meta-analysis were evaluated through subgroup and sensitivity analysis. Results: 0.86, P<0.05). Conclusions: In the assessment of patients presenting with acute chest pain in the ED, CTA exhibited higher diagnostic accuracy than hsTn. This indicates that CTA may be more effective in ruling out the presence of ACS in patients with low to moderate risk. However, there was heterogeneity between studies and moderate specificity, which needs to be interpreted with caution.
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Guo et al. (2026) conducted a meta-analysis in Acute coronary syndrome (n=4,239). Computed tomography angiography vs. High-sensitivity troponin was evaluated on Diagnostic accuracy for acute coronary syndrome expressed as area under the curve (AUC) (95% CI 0.94-0.97, p=<0.05). Computed tomography angiography exhibited higher diagnostic accuracy for acute coronary syndrome (AUC 0.96) compared to high-sensitivity troponin (AUC 0.86) in emergency department patients.
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